Efficacy of Multifocal Spectacles for Myopia Control in Pre-myopic Children: A Multicentre Real-world Study

To evaluate the efficacy of multifocal (MF) spectacles, compared with single-vision (SV) spectacles, in controlling myopia progression and delaying myopia onset amongst Chinese children with pre-myopia (spherical equivalent [SE] ≤ +0.75 and >-0.50 D).

A multicentre retrospective case-control study was conducted, with baseline characteristics balanced using propensity score matching (PSM). The participants underwent spherical equivalent refraction (SE) and axial length (AL) measurements. Primary outcomes included SE and AL progression at 6 and 12 months, as well as the 1-year cumulative incidence of myopia (SE ≤ -0.50 D).

A total of 1501 participants (mean age: 8.60 ± 2.26 years; mean SE: 0.00 ± 0.37 D) were included in the analysis, comprising 835 in the MF group and 666 in the SV group. After 12 months, MF spectacles slowed SE progression (difference: -0.35 ± 0.63 D; p < 0.001) and AL elongation (difference: 0.23 ± 0.27 mm; p < 0.001) significantly, compared with the SV group. The proportion of children with rapid myopia progression was significantly lower in the MF group (SE progression > 0.50 D: 20.8% vs. 45.1%, χ² = 78.15, p < 0.001; AL elongation > 0.2 mm: 34.2% vs. 73.5%, χ² = 165.9, p < 0.001). Kaplan-Meier analysis showed a significantly lower 1-year cumulative incidence of myopia in the MF group than in the SV group (42.6% vs. 65.6%; log-rank p < 0.001).

This large-scale, multicentre study demonstrated that MF spectacles effectively slow SE progression and AL elongation and delay myopia onset in pre-myopic children. Despite the inherent limitations of retrospective designs relative to randomised controlled trials, the findings provide strong real-world evidence supporting the potential of MF spectacles as an effective, non-pharmacologic intervention for pre-emptive myopia control.